Mehmet Balcı

Preoperative medical treatment in patients undergoing diabetic foot surgery with a Wagner Grade-3 or higher ulcer: a retrospective analysis of 52 patients

Diabetic foot ulcers (DFU) are one of the most important complications in people with diabetes mellitus. The present study was aimed to retrospectively review the efficacy of at least 1-week medical treatment before any surgical intervention in patients with Grade-3 and higher DFU according to Wagners classification. A total of 52 patients (36 males and 16 females) hospitalized and treated between June 2006 and February 2009 and had initially received therapeutic treatment (local wound care, antibiotic therapy and blood glucose regulation) for a period of at least 1 week were included in the study. The level of amputation, rates of reulceration and mortality in both groups were recorded in the following period of 2 years. Group 1 (did not respond to preoperative medical intervention) included 16 patients where a surgical debridement, flap or skin graft surgery was performed in 2 (12.5%) patients, major amputation was performed in another 2 (12.5%) patients and minor amputation was performed in the remaining 12 (75%) patients. Of 36 patients in Group 2 (did respond to preoperative medical intervention), 5 (13.9%) patients underwent the surgical debridement, flap or skin graft surgery, 8 (22.2%) patients had a major amputation and the remaining 23 (63.9%) patients lead to a minor amputation. The ulcer recurrence and mortality rates were obtained as 2 (12.5%) and 2 (12.5%) in Group 1 and 2 (5.6%) and 1 (2.8%) in Group 2, respectively. Despite the lower rates of ulcer recurrence and mortality in patients having adequate responses to initial treatment before surgical procedures were performed, no statistically significant difference was observed between the 2 groups. In addition, there was no statistically significant difference between the levels of amputation in both groups.

Conjunctival Flora in Diabetic and Nondiabetic Individuals

Objectives: To evaluate the conjunctival bacterial flora in diabetic patients and nondiabetic subjects. Materials and Methods: Fifty-three diabetic patients and 43 nondiabetic healthy individuals were included in the study. A specimen was taken from each participant for the study by rubbing a sterile cotton-tipped swab on the inferior palpebral conjunctiva of the right eye. Samples were incubated in blood agar, chocolate agar, eosin methylene-blue lactose sucrose agar and sabouraud 4% dextrose agar. Isolated microorganisms were identified using routine microbiological methods. Results: Rates for bacterial isolations were determined as 38.5% in diabetic patients and 34.9% in nondiabetic controls. Staphylococcus aureus was isolated in 30% of cases in the diabetic patient group, while 20% tested positive for Escherichia coli, 10% for coagulase-negative Staphylococcus, 10% for Klebsiella pneumoniae and 30% for multiple bacteria. In the non-diabetic group, 53.3% of patients were positive for Staphylococcus aureus while coagulase-negative Staphylococcus was isolated in 26.7%, Klebsiella pneumoniae in 6.7% and multiple bacteria in 13.3% of patients. Although there was no statistically significant difference in the number of isolated bacteria between the diabetic and nondiabetic groups, gram-negative bacterial colonization was significantly higher in diabetic patients (χ2=0.129, p=0.719 and χ2=5.60, p=0.018, respectively). Conclusion: Gram-negative bacteria are more common in the conjunctival flora of diabetic patients. This should be considered by clinicians when treating ocular infections in diabetic patients.

Evaluation of tetanus antibody levels in adults in Yozgat, Turkey.

BACKGROUND/AIM To assess the immune status against tetanus in relation to self-declared vaccination status among an adult population in Yozgat, Turkey. METHODS Questionnaires and blood specimens were collected from 267 individuals over 18 years of age in Yozgat, Turkey. Antitetanus antibodies were determined quantitatively by enzyme-linked immunosorbent assay. RESULTS Among the 267 subjects (mean age 43.4 ± 15.6; male:female, 133:134) 168 (62.9%) had protective level of tetanus antibody titers. There was a characteristic distribution of the tetanus antibody titers in different age groups as it dropped with increasing age. Protective immunity was obtained in 74.1% of urban and 47.9% of rural participants. The lowest immunity was observed among farmers (53.3%) and housewives (55.6%) when compared to other occupations. Protective antibody titers were detected in 25% of the individuals who had not finished any school, while the rate was 83.7% in those who had graduated from university. While the protection rate in women who had been vaccinated during pregnancy was 78.3%, this rate was 39.2% in nonvaccinated women. CONCLUSION Our findings confirm that only 62.9% of the population is immunized against tetanus, with a lack of coverage in particular for the elderly and in rural areas. It is necessary to follow the recommendations for 10-year boosters for tetanus.

Pityriasis rosea: a natural history of pediatric cases in theCentral Anatolia Region of Turkey*

BACKGROUND/AIM This study aimed to evaluate the demographic, clinical, and epidemiological features of pityriasis rosea (PR) in a cohort of 46 children in Yozgat, a city in the Central Anatolia Region of Turkey. MATERIALS AND METHODS Forty-six children with PR were monitored at regular intervals (1, 2, 4, and 12 weeks) for 3 months from the time of diagnosis. A complete evaluation of the patient was performed at each visit. RESULTS The average age of patients at time of diagnosis was 12 ± 3.9 years. Cases were most common in the winter (rainy, snowy months; n = 14, 31%). Fifteen patients had a medical history significant for the presence of upper respiratory tract infection, while skin PR manifestations were preceded by drug intake in a second group of 15 patients. The presence of a herald patch was observed in 78.3% of patients, most frequently on the trunk (n = 23). Pruritus occurred in 75% of patients. Median PR duration was 3 weeks (range: 1-20 weeks). CONCLUSION The course of PR is similar in Turkish children and adults. The high prevalence of pruritus in children with PR in Turkey was also significant. Further evaluation of this finding comparing adults and children is now required.

Cerrahi Alan İnfeksiyonları ve Risk Faktörleri: Türkiye’de Doğu Anadolu Bölgesinde bir Devlet Hastanesinin Sonuçları

Objective: Surgical site infections (SSIs) are a major problem after surgery. They cause to impairment of patient comfort, increase morbidity, mortality, in hospital stay and costs. The aim of this study is to investigate the risk factors affecting SSIs. Material and Methods: One thousand forty patients underwent general surgery procedures at a single state

Combination of The Serological Tests For The Diagnosis of Brucellosis in Endemic Areas

Yard. Doç. Dr. Mehmet Balcı, Bozok Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Yozgat, Türkiye, Tel. 0 354 212 70 60 Email. drmehmet1971@gmail.com Geliş Tarihi: 22.05.2013 • Kabul Tarihi: 03.12.2013 ABSTRACT AIM: The aim of the study is to analyze the effi ciency of combination of RBPT, STAT and ELISA tests on patients with brucellosis where the diagnosis is dependent on the compatible clinical and epidemiological fi ndings with negative RBPT and/or STAT test results.

YÜZ BÖLGESİNDE YERLEŞMİŞ İKİ TİNEA İNKOGNİTO OLGUSU

Tinea incognito is used to describe dermatophyte infections that diagnosed incorrectly and treated with topical or systemic corticosteroids. Two patients with dermatophyte infections in facial ocalization are presented. They had a history of treatment with steroids. Microscobic examination revealed hyphae and spores. The patients responded to topical and systemic antimicotic treatment. As a result, tinea incognito is not a rare clinical entity and can be presented with different clinical forms due to ampirical steroid treatments. Thus, in the cases of atypical, erythematous and scaly plaques, it should not be forgetten that the existence of dermatophytosis should be kept in mind and recovery can be achieved with appropriate antifungal therapy.

Çocuklarda HBV Aşısının Koruyuculuk Oranı ve Anti-HBs Değerlerinin Yaş ve Cinsiyet İle Olan İlişkisi

Objective: The study was aimed to investigate the relationship between seroprotective ratio-Anti-HBs values of HBV vaccine and agegender in children. Method: Seven months and older-aged 143 children who underwent a three-dose HBV vaccination schedule were included in the study with family consent. Children having the last vaccination within the last month were excluded. Children were divided into 4 groups: 7-24 months, 25-48 months, 49-60 months and above 61 months. HBsAg and Anti-HBs levels were determined in all cases. Results: The seroprotective ratio of Anti-HBs values of the patients with the mean age of 73.09 months was detected as %80.14. The average values for Anti-HBs were 134.8 mIU/mL for male and 154.5 mIU/mL for female patients. No statistically significant difference between age gorups and sexes in terms of Anti-HBs positivity was observed. Conclusion: Immunization activities should be continued without interruption and the vaccination efficacy should be monitored consistently by studies